Abstract

Primary PCI of an occluded artery after läte referral and in haemodynamically stable patients can often cause complications and is not indicated after 24 hours.

Case report: acute hospitalisation of a 43-year-old male with no previous cardiac anamnesis after a symptom onset of 20-24 hours. Referral ECG showed inferior leads Q waves and ST elevation. Dynamics of cardiac markers and pain onset denoted ca 24 h late-referral myocardial infarction. Coronary angiography via the radial route revealed left coronary tree without significant stenooses and an occluded right coronary artery with no visible collaterals. Effective aspiration with the 6F Eliminate catheter was done in the occlusion part. Direct stenting was performed with 3.0×24 mm MGuard net protected stent. There was no residual stenoosis and good (TIMI3) flow was achieved. Intravenous antiplatelet Integrilin was started according to body mass dosage instructions. Echocardiographically ejection fraction 55%, inferoseptal hypokinesis. In the course of two-year follow-up exercise test (Treadmill BRUCE) was performed with good exercise tolerance and 13.5 MET, no ischaemia.

In acute cases it is difficult to collect anamnesis and to distinguish between prodrome and real pain onset; the operaator has to consider a number of angiographic images. Distal embolization as a separaate negative prognosis marker can be reduced or avoided by mechanical devices.